Ohio Introduces Bold PBM Reform Bills to Protect Pharmacies and Patients

Ohio PBM reform bills – bipc.com online article | September 26, 2025

Ohio is making headlines with a series of bills that could transform the pharmacy benefit manager (PBM) landscape. Legislators recently introduced House Bill 229, Senate Bill 210, and House Bill 192—three companion bills designed to bring fairness, transparency, and accountability to PBM practices. If enacted, these reforms will give independent pharmacies, insurers, and patients stronger protections against unfair practices.

A New Era of Oversight

Introduced in April and June 2025, these bills aim to establish a comprehensive state-level regulatory framework for PBMs. Ohio would join a growing number of states demanding that PBMs operate under stricter supervision. By doing so, lawmakers hope to end opaque business practices and bring more fairness to the prescription drug supply chain.

Key Objectives of the Legislation

The proposed reforms are built around three core goals:

Enhance Transparency: Require PBMs to disclose rebates, payments, and pricing practices so insurers and plan sponsors can track how money flows through the system.
Protect Independent Pharmacies: Ensure PBMs cannot reimburse their own affiliates at higher rates than they pay community pharmacies.
Hold Insurers Accountable: Give plan sponsors clearer rules for monitoring PBM performance and rebate pass-through.

Licensing and Conduct Requirements

Under the new rules, all PBMs operating in Ohio must obtain a license from the Superintendent of Insurance, with a $2,000 filing fee. This isn’t just paperwork—it creates a gateway for ongoing oversight.

The bills also crack down on discriminatory reimbursement practices. PBMs will be prohibited from paying their affiliated pharmacies more than independents for the same services, leveling the playing field and stopping anti-competitive behavior.

Transparency Through Documentation

The legislation puts transparency at the forefront. PBMs must maintain detailed documentation of:

Total rebates received and distributed
Rebates passed on to enrollees at the point of sale
Comprehensive breakdowns of payments to and from payors and pharmacies

The Superintendent of Insurance can audit these records at any time, ensuring PBMs stay compliant.

Protecting Pharmacy Networks

House Bill 192 adds another layer of protection by addressing network participation rules:

Fair Standards: Health plans cannot impose accreditation or certification standards on pharmacies that go beyond the requirements of the Ohio State Board of Pharmacy.
Complaint Process: Any pharmacy or patient harmed by a violation can file a complaint with the Superintendent of Insurance.

These provisions safeguard smaller pharmacies from being excluded by unfair or inconsistent requirements.

Anti-Retaliation Measures

Perhaps the most significant piece of the reform is the anti-retaliation provision. PBMs will be explicitly prohibited from punishing pharmacies that exercise their rights or report violations. The law bars PBMs from:

Terminating contracts without at least 90 days’ notice
Increasing audits without proper justification and advance notice
Withholding timely payments

Pharmacies that believe they have been retaliated against can file formal complaints, giving them a clear path to seek justice.

Enforcement With Real Consequences

If a PBM violates these laws, the Superintendent of Insurance can issue a notice requiring correction within 60 days. This quick enforcement mechanism ensures compliance and reinforces the seriousness of the reforms.

What This Means for Ohio

If passed, these bills will:

Create a transparent and equitable PBM marketplace
Empower independent pharmacies to fight unfair practices
Protect patients from access delays caused by PBM manipulation
Give insurers and plan sponsors clearer oversight tools

For patients, this means faster access to prescriptions and fewer battles over coverage. For pharmacies, it means fairer reimbursements and freedom from retaliation.

Why RescueMeds Supports PBM Reform

At RescueMeds, we know how damaging PBM practices can be. From clawbacks to unfair reimbursements, these tactics harm patients and independent providers alike. That’s why we support reforms like Ohio’s bills, which aim to bring fairness, accountability, and transparency to the system.

When states stand up to PBMs, patients win. And at RescueMeds, our mission is clear: deliver timely medications to injured workers and fight back against the barriers PBMs create.

Rescuemeds